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Impact of reflux esophagitis on the esophageal function before and after laparoscopic fundoplication.
- Source :
-
Esophagus : official journal of the Japan Esophageal Society [Esophagus] 2018 Oct; Vol. 15 (4), pp. 224-230. Date of Electronic Publication: 2018 Apr 26. - Publication Year :
- 2018
-
Abstract
- Background: High-resolution manometry (HRM), which is breakthrough testing equipment to evaluate esophageal motor function, was developed in Europe and United State and has garnered attention. Moreover, multichannel intraluminal impedance pH (MII-pH) testing has allowed us to grasp all liquid/gas reflux including not only acid but also non-acid reflux. We examined the impact of the presence of reflux esophagitis (RE) on esophageal motor function before and after laparoscopic fundoplication.<br />Materials and Methods: The subjects included 100 patients (male: 63 patients, mean age: 54.1 ± 15.8) among 145 patients who underwent laparoscopic fundoplication for GERD associated diseases during a 4-year period from October 2012 to September 2016, excluding 6 patients who underwent further surgery, 32 patients on whom HRM was not performed, 3 patients who had technical errors during testing, and 4 patients for whom the status of RE was unknown. Regarding HRM, Mano Scan from Given Imaging Ltd. was used, and for the analysis, Mano View version 3.0 from the same company was used, after which data was calculated based on the Chicago Classification advocated by Pandolfino et al. Moreover, for the MII-pH testing, Sleuth manufactured by Sandhill Scientific. Inc. was used and automatic analysis was conducted by a computer. Postoperative assessments were conducted 3 months following surgery for all. Data was described in the median value and inter-quartile range, with a statistically significant difference defined as p < 0.05 by Chi square, Mann-Whitney, and Wilcoxon tests.<br />Results: RE+ group (Los Angeles classification A:B:C:D = 7:9:16:12 patients) included 44 patients (44%), of older age compared to the RE- group (62 vs. 50 years, p = 0.012) and a higher Body Mass Index value (24.0 vs. 22.5, p = 0.045); however, no differences were observed in terms of gender and duration of symptoms. In the preoperative findings on MII-pH, the RE+ group demonstrated significantly longer acid reflux time (4.7 vs. 1.3%, p = 0.005), while in the HRM findings, the RE- group demonstrated a significantly longer abdominal esophagus (0 vs. 0.4 cm, p = 0.049) and maintained esophageal body motor function (DCI: 1054 vs. 1407 mmHg s cm, p = 0.021, Intact peristalsis ratio: 90 vs. 100%, p = 0.037). As to the comparison of the treatment effect before and after laparoscopic fundoplication (Toupet fundoplication for all), significant improvements were observed in both groups in various parameters regarding reflux including acid reflux time, total number of liquid reflux episodes and total number of reflux episodes. Moreover, for both groups, the total length of the lower esophageal sphincter (LES) (RE+ group: 2.7 vs. 3.2 cm, p = 0.001, RE- group: 3.0 vs. 3.4 cm, p = 0.003) and the total length of the abdominal esophagus (RE+ group: 0 vs. 1.6 cm, p < 0.001, RE- group: 0 vs. 1.8 cm, p = 0.001) were significantly extended following surgery; however, no change was observed in DCI before and after surgery.<br />Conclusions: Regardless of the presence of RE, cardiac function and LES function were improved following laparoscopic Toupet fundoplication, but no changes were observed in esophageal body motor function.
- Subjects :
- Adult
Aged
Electric Impedance
Endoscopy, Digestive System methods
Esophageal Motility Disorders complications
Esophageal Motility Disorders diagnostic imaging
Esophageal Sphincter, Lower anatomy & histology
Esophageal pH Monitoring methods
Esophagitis, Peptic diagnostic imaging
Esophagitis, Peptic surgery
Female
Gastroesophageal Reflux complications
Humans
Male
Manometry instrumentation
Middle Aged
Postoperative Period
Preoperative Period
Esophageal Motility Disorders physiopathology
Esophageal Sphincter, Lower physiopathology
Esophagitis, Peptic complications
Fundoplication methods
Gastroesophageal Reflux surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1612-9067
- Volume :
- 15
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Esophagus : official journal of the Japan Esophageal Society
- Publication Type :
- Academic Journal
- Accession number :
- 30225739
- Full Text :
- https://doi.org/10.1007/s10388-018-0618-8